Does Your Health Insurance Cover Addiction Treatment?
The cost of rehab is a significant obstacle that prevents many people with substance use disorder (SUD) from getting the help they need. Fortunately, most health insurance plans can be used to make addiction treatment much more affordable.
There are several laws that make it so that most people with health insurance are covered if they need treatment for mental health or substance use issues.
The Mental Health Parity and Addiction Equity Act (MHPAEA) mandated that health plans that provide coverage for these conditions must provide it at the same level they do for medical care and surgery.
The Affordable Care Act (ACA) established the health insurance marketplace, expanding access to health insurance for millions of people and removing many restrictions that affected coverage for substance use and mental health treatment. For example, government-funded plans (like Medicaid and Medicare) must cover addiction treatment. The same goes for small-group insurance plans and plans purchased through the health insurance marketplace (and state equivalents). It is also illegal for any plan to deny coverage on the basis that a member is suffering from a “pre-existing condition.”
While most health plans cover addiction treatment, the level of coverage may vary greatly plan to plan. Typically, plans with low monthly premiums require members to pay higher out-of-pocket costs when they opt to use their coverage. Conversely, plans with high monthly premiums usually have lower out-of-pocket costs for treatment.
How to Use Health Insurance for Addiction Treatment
The first step in using your health insurance to treat addiction is find a rehab center that is within your care network. In most cases, getting treatment at a facility that is outside this network will result in you having either no coverage at all or very limited coverage.
You can find out whether a facility is within your insurer’s network by contacting the treatment center or your insurer. However, this process is even simpler at Greenhouse Treatment Center, which allows you to
You’ll need to provide your:
- Email address.
- Name of your health insurer.
- Policy number.
If you prefer, you can also ask an admissions navigator your insurance questions directly by calling .
How Much Does Addiction Treatment Cost with Insurance?
Unfortunately, there are far too many variables involved to give a simple answer. Out-of-pocket costs depend on:
- The treatment facility itself and whether it is within the insurance network.
- The type of treatment provided (inpatient, outpatient, etc.) and its duration.
- The specific insurance plan.
Reviewing your Summary of Benefits and Coverage package will give you a better idea of how your coverage applies to addiction treatment.
Often, you’ll have to pay a deductible before your insurance begins providing coverage. After this is paid, you’ll likely have to pay a co-insurance rate to share costs of the treatment. For example, if your rate is 20%, insurance will cover the remaining 80% of costs. In other cases, co-payments may be charged for each visit to an outpatient facility.
The out-of-pocket limit/maximum is the most you can be charged for eligible health services within a year (except for monthly premiums, which you’ll still owe). After you’ve paid this amount, your insurance will cover 100% of the remaining costs.
If you or a loved one is struggling with addiction, it’s not too late to get help. Please reach out to an admissions navigator at to learn more about care at Greenhouse Treatment Center.